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PubMed2005

Screening for correctable visual acuity deficits in school-age children and adolescents.

BACKGROUND: Although the benefits of vision screening seem intuitive, the value of such programmes in junior and senior schools has been questioned. In addition to this there exists a lack of clarity regarding the optimum age, and frequency at which to carry out screening. OBJECTIVES: The objective of this review is to evaluate the effectiveness of vision screening programmes carried out in schools in reducing the prevalence of undetected, correctable visual acuity deficits due to refractive error in school-age children. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) on The Cochrane Library (Issue 3 2004), MEDLINE (1966 to August 2004) and EMBASE (1980 to August 2004). No language or date restrictions were placed on these searches. To date it has not been possible to carry out any manual searches but it is hoped to include these in a future update. SELECTION CRITERIA: We planned to include randomised controlled trials including randomised cluster controlled trials. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study abstracts identified by the electronic searches. No trials were identified that met the inclusion criteria. MAIN RESULTS: As no trials were identified, no formal analysis was performed. A narrative synthesis of other retrieved studies was undertaken in order to explain current practice. AUTHORS' CONCLUSIONS: At present there are no robust trials available that allow the benefits of school vision screening to be measured. The disadvantage of attending school with a visual acuity deficit also needs to be quantified. The impact of a screening programme will depend on the geographical, and socio-economic setting in which it is conducted. There is therefore clearly a need for well planned randomised controlled trials, in various settings, to be undertaken so that the potential benefits and harms of vision screening can be measured.

Adolescent↗
PubMed2000

Photoscreening for amblyogenic factors by public health personnel: the Eyecor Camera System.

OBJECTIVES: This pilot study was designed to assess the ability of a photoscreening camera to detect amblyogenic factors such as high refractive error, anisometropia, media opacities and strabismus in children, compared to the standard vision screening techniques employed by the local state public health screening personnel. METHODS: Public health personnel in Illinois used the Eyecor prototype to the current commercially available MTI PS-100 photoscreening camera (manufactured by Medical Technology Inc.) to screen 127 non-dilated subjects, ages 7 months to 20 years (mean age, 6 years), for amblyogenic factors. All participants were concurrently subjected to the "standard" vision screening employed routinely by state public health personnel. The study participants included a group of normal inner-city children and one group of special-needs children. The normal children came from both a public school and a private school. The special-needs children included a group of children from a state-run school for the deaf and hard-of-hearing and a separate group of children attending a multi-disciplinary Easter Seals clinic. RESULTS: In the population of normal children, the mean sensitivity and specificity for the observers using the Eyecor Camera system was 81% and 83% with a mean positive predictive value of 83%, and a mean negative predictive value of 55%. Standard vision screening techniques employed by public health service certified vision screeners had a sensitivity of 88%, a specificity of 91%, a positive predictive value of 67% and a negative predictive value of 97% in the same subjects. In the population of special-needs children with hearing impairment and developmental delay, the mean sensitivity and specificity for the observers using the Eyecor Camera system was 74% and 82% with a mean positive predictive value of 69% and a mean negative predictive value of 85%. Standard vision screening techniques employed by public health service certified vision screeners had a sensitivity of 100%, a specificity of 55%, a positive predictive value of 62% and a negative predictive value of 100% in the same subjects. (See Table 1) CONCLUSIONS: This study shows that the Eyecor Photoscreening Camera is useful in screening normal children for amblyogenic factors. Photoscreening was at least as effective as standard screening methodologies performed by certified vision screeners as required by state public health policy. In addition, photoscreening is particularly useful in testing those children "unscreenable" by conventional vision screening procedures.

Adolescent↗
PubMed1998

A new approach to visual acuity screening for pre-school children.

The Melbourne Initial Screening Test (MIST) is a vision screening technique which combines the features of an established procedure, the five-letter Sheridan Gardiner Single (SGS) test, with a pass/fail method of assessment. It is a simple screening test for children aged 3.5-4.5 years, which is designed to be easy to use. This paper reports on the preliminary results of a comparison of threshold acuity using the 5-letter single-optotype Sheridan Gardiner (SG) test and the MIST results obtained by orthoptists, and a comparison of MIST results obtained by orthoptists and child health nurses. The orthoptists tested 225 children and the nurses tested 868 children. The MIST results obtained by the orthoptists were similar to the SGS in that there was agreement between the test results in 202 (94%) cases. The MIST has a similar rate of subject compliance (95%) as the SGS test (96%). The rate of compliance for orthoptists' and nurses' use of the MIST was similar, with 97% of children being compliant for the nurses and 96% for the orthoptists. The results suggest that the MIST, using a pass/fail method of assessing visual acuity compared to an assessment of threshold visual acuity, may be useful as part of pre-school vision screening since it is easier than the traditional testing of threshold visual acuity and gives similar results to the SG single-optotype test.

Child, Preschool↗
PubMed2003

[Visual screening to discover ophthalmologic disorders in children].

PURPOSE: [corrected] To report the frequency of common childhood ocular disorders in a pediatric population. To address the issue of access to care for vision screening programs. METHODS: Prospective vision screening for a period of 2 years (February 2001-February 2003) which enroll 254 children from 3 villages (Cepleniţa, Vlădeni, Aroneanu) sponsored by World Vision Romania. The study asses refractive errors, strabismus, amblyopia and other ocular abnormalities. RESULTS: The mean age was 8.09 +/- 2.88 with the following distribution: preschool 19%, first grade 56%, second grade (over 10 years of age) 25%. Refractive errors requiring correction were observed frequently in this group of children (especially mild hyperopia, small myopia, astigmatic refractive errors). Strabismus was identified în 7.87% of cases and amblyopia în 11.42% (1/3 of cases mild and severe). CONCLUSIONS: The frequency of common visual disorders in this population sample was larger than previously published studies. In poor economic subgroups the first ophthalmologic examination was performed after school age. Access to care is an integral part of any vision screening program. We are trying to highlight the importance of effective follow-up programs for all children especially those with limited resources for health care.

Adolescent↗
PubMedDate not supplied

The impact of the "Put Prevention into Practice" initiative on pediatric nurse practitioner practices.

INTRODUCTION: Pediatric nurse practitioners (PNPs) are committed to health promotion and disease prevention, especially for children and adolescents. In this project the "Put Prevention into Practice" materials, developed by the Office of Disease Prevention and Health Promotion of the United States Public Health Service, were disseminated to members of the National Association of Pediatric Nurse Associates and Practitioners and evaluated for their impact on child health outcomes. METHOD: The evaluation was conducted by chart review of patients seeing PNPs during the first year of national implementation of the project. Data were collected on a form designed for the study at the time of introduction of the materials into the PNPs' practice and 6 months later. Numbers of visits for health maintenance, illness, and emergency department use were compared before and after introduction of materials. Whether the parent brought the Child Health Guide to the visit was also compared before and after materials were introduced. In addition, immunization status, recording of height, weight, developmental screening, and hearing and vision screening were compared before and after introduction of materials. To obtain information about the materials and their applicability to patients, focus groups were used to elicit information from PNPs at two national meetings. RESULTS: Usable data were received from 14 PNPs representing 194 patients. The results indicated that use of the "Put Prevention into Practice" program increased immunization rates, health maintenance visits, documentation of developmental, hearing and vision screening, and car seat use. No change was seen in documentation of height, weight, and emergency department and illness visits. Members found that the materials were difficult to implement in some populations. Despite the small numbers of participants, these data suggest that use of the "Put Prevention into Practice" materials can improve consistency of preventive care for young children.

Child↗
PubMed1984

AOA Sports Vision Section screening of basketball officials.

Members of the Sports Vision Section of the AOA screened 60 basketball officials. Tests included: visual acuity, ocular motilities, accommodative facility, Brock string, Wayne saccadic fixator, vectogram, Keystone visual skills, and tachistoscope. Results demonstrated that officials' vision was at a very high level and compared favorably with the results from the recent National Sports Festival screenings.

Adult↗
PubMed1978

Physical health of ten-year-old children. An epidemiological study of school children and a follow-up of previous health care.

At 10 years of age, all 223 children in a school district underwent a physical examination and a screening for vision and hearing defects within the school health services. The purpose of the study was to detect health problems of importance for the day-to-day functioning of the child. In 26.1% significant deviations were found. Physical disorders comprised 11.7% visual defects 11.7% and auditory impairment 2.7%. The vast majority of significant health problems were previously known and in only 4.4% of the 223 children newly detected, 0.9% by the physical examination, 2.7% by the vision screening and 0.9% by the auditory screening. The most frequent health problem of all was allergy in 13.5%, in 5.4% regarded as functionally important. Minor orthopaedic deviations and motor disturbances were common but not often considered to affect the functioning of the child significantly. As a whole, the children's health was very good and the outcome of the physical examination at this age was not impressive. It is evident that the physician's role in the school health system needs to be reconsidered.

Blood Pressure↗
PubMed2006

Statewide quality improvement outreach improves preventive services for young children.

OBJECTIVE: Although clinical trials demonstrate the efficacy of quality improvement outreach in improving service delivery, evidence for broad community effectiveness has been lacking. The objective of this study was to test the effectiveness of a statewide pediatric quality improvement outreach program in improving preventive services for children who are younger than 5 years. METHODS: All pediatric practices in Vermont (n = 35) were invited to participate in a preventive services quality improvement initiative. Ninety-one percent agreed. Participating practices serve >80% of all Vermont children who are younger than 5 years. The main outcome measured was change in 9 preventive services areas: (1) immunizations up to date; (2) anemia screening; (3) tuberculosis risk assessment and indicated screening; (4) lead screening; (5) infant sleep position counseling; (6) environmental tobacco smoke-exposure risk assessment; (7) blood pressure screening; (8) vision screening; and (9) dental risk assessment. RESULTS: All practices demonstrated improvement in 1 or more preventive services areas. The mean number of areas chosen was 5 (range: 1-9). Practices that selected a specific preventive service area as a quality improvement goal were more likely to demonstrate improvement in that area than practices that did not choose to focus on that preventive services area. CONCLUSIONS: The work in this project has provided the evidence for an effective statewide pediatric quality improvement outreach program to improve preventive services for children who are younger than 5 years. Practices' decision to focus on a specific preventive service area as a quality improvement goal seems necessary for improvement in that area. This approach may be effective in other states or regions.

Child Health Services↗
PubMed1993

[The detection of vision disorders in children].

Using recognized criteria, the author discusses the merit of preschool vision screening programs and presents a number of recommendations for the detection of amblyopia, strabismus, and other visual impairments.

Adolescent↗
PubMed1988

A new test for screening color vision: concurrent validity and utility.

Recognizing the need for an effective test for screening color vision in young children, we have developed a new pseudoisochromatic (PIC) plate test which is useful for a wide variety of observers at different ages. The test consists of four plates and responses can be used to categorize color vision as normal or as either red-green or blue-yellow defective. Results of this validation study with adults, both color normal and red-green defective, show a high degree of correlation between the new test and the Nagel anomaloscope: there were no false positives and only a few false negatives, which occurred with mild deuteranomalous observers. The validity of the test compares favorably to the Ishihara, F-2, and the AO-HRR screening plates. Results with toddlers (3 to 6 years) indicate that the task demands of the test are well suited for testing young children. The percentage of color defectives identified in the toddler sample using the new test is closer to the adult prevalence than results obtained with the F-2 and AO-HRR screening plates, which gave dramatically higher failure rates. The new test is culture-free and can be administered rapidly to both verbal and nonverbal observers using pointing or preferential looking.

Adult↗
PubMed1998

[Screening for amblyopia, strabismus and refractive abnormalities in 1,030 kindergarten children].

BACKGROUND: There are controversies concerning the necessity of pre-school vision screening. AIM OF THE STUDY: evaluation of the prevalence of pathologic ophthalmologic findings in kindergarten children. MATERIALS AND METHODS: 1030 families were offered a vision screening. Of these, a total of 948 children, aged 3 to 6 years, voluntarily underwent a screening for strabismus, amblyopia and refractive anomalies. The examination was performed in the kindergarten in the absence of the parents. METHODS OF EXAMINATION: A questionnaire concerning general and ophthalmologic history of the child and of the family was evaluated. Visual acuity, cover-uncover-test, Lang-stereotest, retinoscopy, ophthalmoscopy (undilated pupils) were performed and the glasses were evaluated. RESULTS: The screening was highly accepted by the parents and 92% of the families (n = 948) took part. The compliance of the children was very good. A total of 38.7% (n = 381) of the children showed one or more abnormal parameters. 21.4% (n = 229) showed a reduced visual acuity. Strabismus was found in 3.7%. Half of the children with abnormal findings already had had a vision screening, but only 25% had received ophthalmologic treatment. Of those who possessed glasses, 25% came without them, and another 25% had a reduced visual acuity even with their glasses. The main problems were many false-positive results and high costs. CONCLUSIONS: Ophthalmologic and orthoptic screening in kindergarten is technically easy and conclusive in experienced hands. Ideas to reduce costs and to avoid overreferrals are an age-related lowering of the visual acuity limit and a rescreening of suspected children in a screening-setting a second time before sending them to an ophthalmologist. Another possibility to reduce costs would be to perform examinations not by ophthalmologists but by "screening-orthoptists" who should be trained in retinoscopy and ophthalmoscopy.

Amblyopia↗
PubMed1990

Advances in vision and eye screening: screening at six months of age.

Eye and vision screening is a prototype preventative health measure. Increased knowledge of eye diseases in children and their treatment mandates much earlier screening than was recommended in the past. Advances in testing permit both the adoption of simpler and faster routine techniques and the application of more sophisticated and accurate screening methods. A thorough vision/eye screening at 6 months of age has been added to the previous examination schedule which only required screening at birth and again at 3.5-4 years of age. The simple scrutiny of the red fundus reflexes in the pupil with a direct ophthalmoscope (Brückner test) provides superior screening for vision, binocular alignment and pathology in infants. The difficult-to-master cover test and its variants can be abandoned for screening purposes. In screening preverbal children, simple optotype charts (HOTV) are proving more efficient than the traditional 'tumbling E' game. Color vision testing should be added to the preschool examination. Vision screening in infants can be enhanced where resources permit by using new preferential looking tests and by employing sophisticated electrophysiological testing. Photographic screening methods based on the red reflex hold considerable promise for more efficient screening of children.

Child↗
PubMed1976

Neonatal at risk factors, visual defects and the preschool child: A report from the Queen Mary Hospital multidisciplinary child development study.

An experimental group of 142 children aged four years who had experienced neonatal at risk factors and a control group of 112 children whose perinatal histories were optimal had vision screening tests to detect defective vision or strabismus. Five (3.5 percent) in the at risk group and 10 (8.9 percent) in the control group (total 15, 5.9 percent) were found to have a visual defect. Of those, six had already been identified because of a manifest squint. Nine children with defective vision were first identified through the study. The importance of the early identification and treatment of visual disorders, particularly amblyopia, is emphasised, and recommendations are made for more widespread vision screening of preschool children.

Amblyopia↗
PubMedDate not supplied

Vision, visual-information processing, and academic performance among seventh-grade schoolchildren: a more significant relationship than we thought?

OBJECTIVE: To compare visual and visual-information processing skills between children with and without mild reading and academic problems and examine the incidence of visual deficits among them. METHOD: Seventy-one seventh graders classified as proficient (n = 46) and nonproficient (n = 25) readers were compared with respect to scores on an accepted vision screening, on tests of visual-perception, visual-motor integration, and academic performance. Further, academic performance and visual-information processing were compared between children who failed and passed the vision screening. RESULTS: Visual deficits were found in 68% of the participants, and among significantly more boys than girls. Nonproficient readers had significantly poorer academic performance and vision-screening scores than the proficient readers. Participants who passed the visual screening performed significantly better in visual perception than those who failed. CONCLUSION: Visual function significantly distinguishes between children with and without mild academic problems, as well as on visual-perception scores. The high occurrence of visual deficits among participants warrants consideration of vision deficits among schoolchildren with academic performance difficulties.

Achievement↗
PubMed1988

Screening of vision in school: could we do better by doing less?

Assessment of vision in schoolchildren is routinely performed, but the effectiveness of the screening programmes has not been reviewed. A survey of health district screening programmes for vision in schools was performed at the end of 1984. The response rate from districts in England and Wales was 81%. All 165 of the districts that responded screened for loss of distant visual acuity; 96% screened for loss of colour vision, 73% for squint, and 67% for loss of near visual acuity. The frequency with which districts screened varied considerably. Some districts screened yearly, and various different types of tests were used. In many districts children were screened in unsuitable places, such as corridors, assembly halls, and toilets. Criteria for referral varied from one district to another, and few districts collected data appropriate for monitoring their screening programmes. Many districts screened more intensively than could be justified on the basis of the conditions tested for and the likely benefit of remedial treatment.

Child↗
PubMed2000

Screening for amblyopia in preverbal children with photoscreening photographs: II. Sensitivity and specificity of the MTI photoscreener.

OBJECTIVE: To determine the sensitivity and specificity of vision screening using the Medical Technology and Innovations (MTI), Inc., PhotoScreener. DESIGN: Cross-sectional study. PARTICIPANTS AND TESTING: Three hundred ninety-two children less than 4 years of age received a complete ophthalmologic examination and were photographed using the MTI PhotoScreener. One hundred three children had normal examinations, and the remaining 284 children had conditions of interest for pediatric screening: ptosis, media opacity, refractive error, or strabismus. Five children were excluded. MAIN OUTCOME MEASURES: The grading of the photographs by the manufacturer's representative was compared with the results of the ophthalmologic examinations. Sensitivity and specificity of vision screening were determined. RESULTS: The analysis of all informative photographs resulted in a sensitivity of 65% and a specificity of 87%. The sensitivity of detection for children with some forms of strabismus was high, up to 95% for esotropia of 10Delta or more. Sensitivities for the detection of ptosis, media opacity, and refractive error were poor in patients where strabismus was not also present. CONCLUSIONS: The MTI PhotoScreener may play a role in preverbal vision screening; identification of two of three children with amblyopiogenic factors before age 4 would be an exciting advance in public health. However, improvement in the ability to identify children with media opacity and refractive error is necessary. Improvements may be possible with modifications of the examination failure and photograph grading criteria.

Amblyopia↗
PubMed2005

Predictive value of photoscreening and traditional screening of preschool children.

PURPOSE: To compare the usefulness of traditional vision screening and photoscreening of 3- and 4-year-old children in the pediatrician's office. METHODS: Following training of pediatricians and office staff, six pediatric clinics used both the MTI PhotoScreener (Medical Technology Industries, LLC, Riviera Beach, FL) and traditional acuity and stereopsis screening materials (HOTV charts/Random Dot E tests as recommended by established AAP-MCHB-PUPVS guidelines) during well-child exams. Clinics used one testing method for a 6-month period and switched to the other for the following 6 months, in a randomized manner. Referred children received a complete eye examination with cycloplegic refraction by local ophthalmologists or optometrists who forwarded the results to Vanderbilt Ophthalmology Outreach Center. Amblyogenic factors were defined using standardized published criteria. RESULTS: Six hundred five children were screened with the photoscreener and 447 were screened with traditional techniques. Mean time for screening was less with the photoscreener: 2.5 versus 5.9 minutes ( P < 0.01). Untestable rates were similar (18% vs 10%, respectively P = NS), but higher with the photoscreener due to one clinic's 70% unreadable rate. Referral rates were also similar: 3.8% versus 4.5%. The positive predictive value (PPV) rate differed greatly. With follow-up results obtained from 56% of referred children, 73% of photoscreening referred children (8/11 examined) had amblyogenic factors confirmed on formal eye exams, whereas all children referred using traditional screening methods (10/10 examined) were normal. CONCLUSION: Photoscreening is more time efficient than traditional screening and has a significantly higher PPV in 3- and 4-year-old children. This study was unable to validate traditional screening techniques in this preschool age group. If these results can be replicated, support for traditional vision screening must undergo intense scrutiny, and attention should be turned toward making photoscreening feasible for widespread implementation.

Amblyopia↗
PubMed1996

Prevalence of visual disorders in Chinese schoolchildren.

We performed a vision screening of 1883 Chinese schoolchildren from 4 schools around Kuala Lumpur in June 1990. The group contained 1083-males and 800 females. Visual acuity, refractive error, oculomotor balance, and axial length were measured. The prevalence of myopia in Chinese schoolchildren was found to be 37% in the 6- to 12-year age group and 50% in the 13- to 18-year age group. Approximately 63% of the sample had unaided visual acuity of 6/6 or better and 24% had unaided acuity of 6/12 or worse. Six hundred twenty-five students (33%) failed the vision screening test and were referred for further examinations. The group which failed the vision screening test and had the highest rate of referral (46%) was the 11- to 12-year-old age group. The most common visual disorder was uncorrected myopia, accounting for 38% of the referrals (235 students). Only 26% of the sample were wearing a spectacle correction.

Adolescent↗